National Marine Sanctuary Advisory Council
Application Form
Before applying for sanctuary advisory council membership, please review:
(1) the sanctuary advisory council charter provided in your application kit, and;
(2) the Office of National Marine Sanctuaries (ONMS) National Marine Sanctuary Advisory Council Implementation Handbook available online at https://sanctuaries.noaa.gov/management/ac/ (or you may obtain a copy from your local sanctuary—see contact information below).
The charter outlines the purposes and governs the operation of the sanctuary advisory council. The handbook provides broader operational requirements for sanctuary advisory councils. In applying for sanctuary advisory council membership, you are agreeing to abide by the terms of the charter and the handbook if you are selected as a council member or alternate.
As a part of the selection process, please note the Office of National Marine Sanctuaries will conduct a LEXIS/NEXIS check and a departmental bureau check for potential conflict of interest and other issues in your background.
Additionally, as per guidance from the White House Office of Management and Budget on May 7, 2009, the Office of National Marine Sanctuaries will conduct a database search (via the Senate’s Lobbying Disclosure Act Database) to determine if you have been a federally registered lobbyist. Individuals who have been federally registered lobbyists in the two-year period before the proposed appointment date for the advertised council seat(s) may not be selected as an advisory council member or alternate if they would be serving in individual capacities.
Additional information and guidance regarding the use of the information you submit on this form and its availability under federal law can be found at the end of this form. Please review this information.
Sanctuary advisory council members and alternates must be 18 years of age or older, with the exception of individuals filling youth seats.
Please note that federal government employees are not allowed to sit on sanctuary advisory councils in a personal capacity. State employees and members of a state legislature are allowed to apply to sit on sanctuary advisory councils in a personal capacity. State employees must provide a letter of support on official agency letterhead from their state supervisor at the time they submit their applications. Members of state legislatures are not required to provide such letters of support.
Please indicate which advertised seat(s) (e.g., Research, Education) and position(s) (i.e., council member or alternate) you are applying for, provide your contact information, and respond to the questions below. The Office of National Marine Sanctuaries may consider applicants for seats and positions for which they have not applied if the Office of National Marine Sanctuaries believes they are qualified for that seat and are willing to serve in it.
The application deadline is [insert date]. Please return all pages of your completed sanctuary advisory council application form, and any attached statements or documents, to [insert local contact information].
Date: __________________
First Name*:______________ Middle _____________ Last ___________________________
* Please include full first, middle and last names.
Position(s)/Seat(s) applying for: _____ [insert advertised seat and position]
_____ [insert advertised seat and position] _____ [insert advertised seat and position]
____ [insert advertised seat and position] _____ [insert advertised seat and position]
Home Address
Address 1: ____________________________________________________________________
Address 2: ____________________________________________________________________
City:____________________________ State: _______________ Zip Code: ______________
Home Phone:____________________________ Cell Phone: ___________________________
Home Fax: ______________________________ Home E-mail: _________________________
Work Address
Company/Organization: _________________________________________________________
Position/Job Title: ______________________________________________________________
Address 1: ____________________________________________________________________
Address 2: ____________________________________________________________________
City:____________________________ State: _______________ Zip Code: ______________
Work Phone:___________________________ Work Cell: ____________________________
Work Fax: _____________________________ Work E-mail: _________________________
Please answer all of the questions below thoroughly and in numerical order. Answers should appear on a separate attached document with each answer clearly marked with the corresponding question number.
Why are you interested in serving on the sanctuary advisory council?
Explain your views regarding the protection and management of marine or Great Lake resources, including natural (fish, coral reefs, etc.), historic or cultural resources.
Describe your formal community and professional affiliations and employment. In particular, highlight how your particular expertise and experience relate to the goals and uses of the sanctuary and the seat(s) for which you are applying. Be sure to include qualifications that you have or other information that you think would be relevant and beneficial to the advisory council.
Describe what you think is the role of the council, and how you will work to best support the sanctuary as a sanctuary advisory council member or alternate.
Explain how you will coordinate with, consult with, and inform the members of the constituency you will represent, if appointed.
How much time do you have and are you willing to give to participate in sanctuary advisory council activities (e.g., meetings, constituent outreach, retreats, chairing or participating on a subcommittee or working group, and reviewing written materials)?
How long have you lived in the community or area affected by the sanctuary? Please address whether you are a year-round or seasonal resident of the area.
Have you attended previous sanctuary advisory council meetings or sanctuary advisory council working group meetings? If so, please describe your past attendance and participation.
Per the instructions on page 1, state employees must provide a letter of support on official agency letterhead from their state supervisor at the time they submit their applications. If you are a state employee (except members of state legislatures), please ensure your state supervisor's letter is included with this application. Members of state legislatures are not required to submit such letters.
Information obtained through this application process will be used to determine the qualifications of the applicant for membership on the sanctuary advisory council. The Office of National Marine Sanctuaries intends affirmatively to disclose the applications only to Department of Commerce/National Oceanic and Atmospheric Administration staff and other members of the applicant review panel. However, the Office of National Marine Sanctuaries may be required to disclose the applications in response to a court order, a congressional request, or a request from the public under the Freedom of Information Act (FOIA).
If disclosure is requested under FOIA, the Office of National Marine Sanctuaries will endeavor to protect the privacy of applicants by withholding personal information, such as home addresses and telephone numbers. In contrast, statements of philosophy or opinions contained in the application would likely be released. Applying for membership on the sanctuary advisory council is voluntary.
Public reporting burden for this collection of information is estimated to average one hour per response, including the time for reviewing instructions, searching existing data sources, gathering the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Office of National Marine Sanctuaries, 1305 East West Highway, N/NMS, Silver Spring, Maryland 20910.
Notwithstanding any other provision of law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.
Privacy Act Statement
Authority: Section 315 of the National Marine Sanctuaries Act (NMSA) (16 U.S.C. § 1445a) authorizes the establishment of national marine sanctuary advisory councils, for which this information is needed for determining appointments.
Purpose: NOAA’s Office of National Marine Sanctuaries collects this information for the purpose of reviewing and selecting candidates for specific seats on national marine sanctuary advisory councils. Such information may include, among other things, name and other contact information, formal professional and community affiliations, employment and expertise and experience relevant to the goals and uses of the sanctuary, and the seat(s) for which the individual is applying.
NOAA Routine Uses: NOAA will use this information to determine selection of advisory council members. Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a) to be shared among NOAA staff for work-related purposes, as well as with a subset of advisory council members. Disclosure of this information is also subject to all of the published routine uses as identified in the Privacy Act System of Records Notice Commerce/DEPT-11, Candidates for Membership, Members, and Former Members of Department of Commerce Advisory Committees.
Disclosure: Furnishing this information is voluntary; however, failure to provide the information will prevent individuals from being considered or selected for a National Marine Sanctuary Advisory Council seat.
OMB Control #0648-0397
Expires 06/30/2018
| File Type | application/msword |
| File Title | Appendix 4 - Application Form |
| Author | Karen.Brubeck |
| Last Modified By | SYSTEM |
| File Modified | 2018-06-05 |
| File Created | 2018-06-05 |